Some Arkansas hospital executives worry that a recent immigration directive will further strain budgets and prevent them from adequately staffing their facilities.
They say President Donald Trump’s order to impose a $100,000 fee on new international hires on H-1B visas will make the program for some international hires unfeasible.
Leslie Huitt, CEO of Bradley County Medical Center in Warren, said she’s not sure how her hospital or others will fill some positions.
“I think that is going to be the question a lot of us are asking,” she said. “What are we going to do? How are we going to staff our facility?”
Hospitals in Arkansas have used foreign workers in the program to fill critical roles for which they have been unable to find qualified Arkansans, including specialty doctors and lab technicians. Historically, facilities would spend about $10,000 per foreign worker, but at $100,000, the economics simply don’t work.
In September, Trump said in a proclamation that the visa program had been created to bring temporary workers to the United States to perform “additive, high-skilled functions,” but he said it had been exploited to replace American workers with cheaper, lower-skilled labor. But in Arkansas, health care leaders say there aren’t enough qualified American workers to fill the needed positions.
The new fee applies only to those seeking new H-1B visas from outside the U.S., not workers already in the country.
No Arkansas health entity has used the program as much as the University of Arkansas for Medical Sciences, according to U.S. Department of Homeland Security data.
UAMS received 332 approvals for the visa program from 2021 to 2025. The second-largest user of the program was Mercy Clinic-Fort Smith Communities with 30 over the same time period.
The program is also open to other sectors, and a number of large companies in Arkansas have hired workers on H-1B visas, including Walmart, Tyson Foods and J.B. Hunt Transport.
UAMS has had 200-240 employees on H-1B visas over the last five years, and the hospital files 100 to 115 petitions each year for new employees and extensions for current employees, according to UAMS spokeswoman Leslie Taylor.
“UAMS continues to hire individuals on H-1B visas who are already in the United States; however, we are not currently recruiting from outside the country,” Taylor said. “We are actively evaluating alternative options for individuals who are living outside the U.S. to meet staffing, and program needs while remaining compliant with federal regulations.”
‘Drowning Out Here’
Huitt said her Warren hospital has used the visa program on three or four occasions to hire lab techs, all from the Philippines. The hospital has incurred costs of around $10,000 for a foreign employee the hospital is attempting to hire now through the H-1B program.
Huitt says the cost for each one of the foreign employees has been under $20,000 to cover the legal costs associated with hiring through the program.
Employers can’t simply hire foreign workers through the program. Instead, they must actively recruit domestically and show that they have tried unsuccessfully to hire American workers to fill the positions.
International employees who receive the visas are required to stay at their job for three years, but that’s not long enough to justify the expense, Huitt said. “Not to mention the fact that we wouldn’t have $100,000 up front to invest,” she said.
Bradley County Medical Center is facing plenty of other headwinds, like nearby facilities that pay higher salaries and have hired staff away, including one employee the hospital had recruited through the H-1B program.
Huitt said the hospital could consider using the visa program to fill nursing positions but won’t be able to at a cost of $100,000 per applicant.
Huitt said the hospital already closed its labor and delivery unit in 2024 to cut costs.
“We’re drowning out here,” she said.
An Impossibility
Ouachita County Medical Center is also strained, and the hospital’s chief executive says paying a $100,000 fee to bring in a new professional is not in the budget.
The hospital has $8 million in debt and plans to file for bankruptcy by the end of the month, according to CEO Glenda Harper.
In a cost-saving measure this month, the hospital closed its obstetrics unit, which had been losing more than $50,000 a month. The unit delivered 119 babies last year and was projected to deliver just 104 this year.
The hospital has four employees on H-1B visas and they all work in the hospital’s lab.
“Medical techs are hard to come by,” Harper said.
Given the hospital’s financial situation, it won’t be able to pursue employees through the visa program with such a high fee.
“We would not be able to do that,” she said. “And I dare say nor would other rural hospitals. We’re all struggling to get by, so paying $100,000 to acquire one of any kind of professional would pose an impossibility.”
Without the visa program available, Harper said hospitals would have to make sure they are paying a rate that can attract employees and recruit from the schools that are doing medical training no matter how far away they are.
“You try to do more with less people but there’s a limit to what you can do when you have to cover 24/7 and that’s the case,” she said.
A Direct Tax
Jefferson Regional Medical Center has used the H-1B visa program to fill positions for many physician specialties and pursues around five such employees every year at a cost of around $8,000 each, CEO Brian Thomas said.
The international doctors the hospital recruits have typically completed medical school in their home country then come to the United States on a J-1 visa for residencies or fellowships. The hospital uses job boards and other networks to find candidates and has an immigration attorney on staff to help with paperwork, according to Brenna Woodruff, who handles Jefferson Regional’s physician recruitment efforts.
Woodruff said the hospital currently has doctors from India, Syria, Jordan, Pakistan and Guatemala. The doctors sign a contract to work for three years, but some have stayed at the hospital for their entire careers, she said. Some of the doctors have earned permanent immigration status, also known as green card status, and must retain that status for a number of years, depending on their home country, before they can become U.S. citizens, Woodruff said.
The hospital has also hired nurses and lab techs on visas as well. But that will get more expensive with a $100,000 fee, which Thomas said will ultimately hurt the delivery of health care.
“This is going to be a huge direct tax on the health care system,” Thomas said.
Thomas said the expensive fee also does not improve the hospital’s ability to recruit American employees, which he said the hospital already does.
“This talent is otherwise not available to come to rural parts of the country,” he said. “That’s the whole purpose of us using it in the first place. Any suggestion of an additional cost is just a direct impact to the community hospital, regardless of where they are.”
Whether the hospital absorbs the cost or if it finds alternative ways to deliver services, that hurts the hospital’s ability to provide care to patients, Thomas said.
Thomas said all Arkansas hospitals are struggling and divided them into hospitals with cash reserves and those without. He said Jefferson Regional has good cash reserves but that he would not want to draw down the reserve to pay these fees because that would be less money he has to invest in resources for the hospital.
“We’re still going to have to find these resources,” he said. “Through the H-1B program, many times, that’s the only way we can do it. We would love to fill positions with U.S. citizens that are talented and qualified in these areas that we need. But, when you’re talking about hard-to-get specialties, we rely on that program to be able to support recruiting that talent.”
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